The Plan B controversy

EDITOR’S NOTE: This article addresses a specific question regarding whether Catholic hospitals should administer Plan B in rape cases based on the scientific evidence regarding how the drug works. The discussion does not in any way imply that contraceptives are or can be morally licit. The Catholic Church teaches that “every action which, whether in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible” is intrinsically evil (CCC 2370 quoting Humanae Vitae 14).

Plan B is the most popular brand of the drug levonorgestrel, which has been dubbed an “emergency contraceptive” that is popularly known as “the morning-after pill.”

Some Catholics, even actively pro-life Catholics, might be surprised to know that Plan B has for many years been considered acceptable by numerous bishops for use in rape cases. But there is growing evidence that Plan B may work in many instances as an abortifacient.

Dr. Chris Kahlenborn, a Pennsylvania-based physician, researcher, and member of the Catholic Medical Association, has made it his mission to spread the word about the moral and ethical ramifications of Plan B. However, he and his collaborators, who include Dr. Rebecca Peck and Dr. Walter Severs, are increasingly frustrated with the lack of response to their findings. After 20 years of investigating the topic, he is flabbergasted that the science is clear and yet so few bishops in the Unites States have acknowledged the problem. The same goes for most Catholic hospitals and influential organizations such as the National Catholic Bioethics Center.

A sketchy presumption

Hospitals, doctors, and crisis centers most commonly give Plan B to women after they have been raped. It’s believed that the drug, if taken before ovulation, acts to prevent ovulation, and therefore, pregnancy. That was the accepted science in 1995 when Bishop John J. Myers, then the head of the Catholic diocese in Peoria, Illinois, approved its use and established directives that became known as the Peoria Protocol. Many other bishops and Catholic hospitals now refer to these guidelines to justify using Plan B.

“That was the presumption at the time,” Dr. Kahlenborn said of Plan B’s contraceptive nature. “However, I must say, even then, the evidence in favor of that presumption was sketchy at best. I contacted Bishop Myers—the local ordinary of Newark, New Jersey, at the time— about 15 years ago to plead with him to retract the protocol but received a return letter calling me an alarmist.”

Essentially, Plan B is a high dose of progestin birth control pill taken in two separate doses that may cause the destruction of human life within five days of fertilization when given prior to ovulation. According to a study published in the Linacre Quarterly and available at www.Polycarp.org, Plan B prevents pregnancy as a contraceptive only in a minority of cases. Rather than being called an “emergency contraceptive,” a more accurate term for the drug is “emergency abortifacient.”

Father Christopher Kubat, the executive director for Catholic Social Services of Southern Nebraska in the diocese of Lincoln, was involved in Linacre Quarterly publication on Plan B. He confirmed that Plan B is not acceptable to use post-sexual assault.

“In short, Plan B can never be used even after ‘ovulation testing,’ because despite determining that a woman is in the pre-ovulatory period of her cycle, most of them ovulate despite giving Plan B,” Father Kubat said. “The levonorgestrel given in this instance then acts as an abortifacient.”

The dignity of persons (Dignitatis Personae)

Meanwhile, RU-486, which increasingly has come into use in the US and other countries during recent years as a chemical alternative to surgical abortion, is strictly an abortifacient.

While RU-486 is supposed to be banned by Catholic health providers, the United States Conference of Catholic Bishops has not issued a similar condemnation of Plan B. It’s unclear how many Catholic hospitals allow its use, but Dr. Kahlenborn estimates about 75 percent make the emergency contraceptive available.

“This is probably a low figure,” he said. “Studies have shown that about 50 percent of Catholic hospitals dispensed EC about 20 years ago, so the figure is probably higher today. Most bishops have little idea whether their local hospitals dispense EC. Only a handful of bishops have advocated against it.”

Bishops in California, Colorado, Connecticut, Massachusetts, New York, Washington, and Wisconsin allow hospitals in their dioceses to administer the morning-after pill to rape victims. Some hospitals around the country perform an ovulation test in addition to a simple pregnancy test before handing out the drug. Several states have laws requiring hospitals to offer the drug to rape victims.

The Vatican has indicated in the past that the Church should leave the decision to the scientists and researchers. But 10 years ago, when the Holy See issued the document Dignitatis Personae, it said the morning-after pill fell within the sin of abortion and was gravely immoral. A former head of the Pontifical Academy for Life once said there is no exception for Plan B to keep it from being gravely immoral. Another head of the Academy emphasized that the morning-after drug is acceptable as long as it’s classified as a contraceptive in the case of rape and does not terminate a pregnancy.

Under the US bishops’ “Ethical and Religious Directives for Catholic Health Care Services,” Catholic facilities are permitted to dispense emergency contraception to a rape victim but only to prevent ovulation or fertilization. Number 36 of “Ethical and Religious Directives” says it is not permissible to initiate or recommend procedures that destroy an already “fertilized ovum” (human being) or prevent implantation in the womb. In Catholic teaching, that is no longer contraception but abortion.

An abortion mechanism of action

The challenge for Dr. Kahlenborn and his collaborators is to convince the Church that, after administering Plan B, the human being could be destroyed. He is considering making a series of videos to explain the science and the need to examine more closely the ethical ramifications associated with “emergency contraception.” The scientific proof is there, through ultrasounds, to show Plan B fails to halt ovulation in the majority of instances when it is given within a few days prior to ovulation. “These two facts alone point strongly to an abortion mechanism of action, since if you have sperm (which Plan B does not impede) and an egg, you should be getting visibly pregnant, but you are not,” Dr. Kahlenborn said. From a moral perspective, researchers have determined that the drug cannot definitively prevent a pregnancy, and in fact, may terminate it by destroying a human being, which is illicit.

“The main argument that Plan B stops ovulation is not even an argument at this point,” Dr. Kahlenborn continued. “There’s no basis in research for that claim anymore.”

Since there is now legitimate evidence that the drug can cause a chemical abortion, the researchers are pleading that the bishops take the time to reevaluate the evidence and their position.

“The bishops refer to the theologians” for moral guidance, Dr. Kahlenborn explained. “But it really is a scientific question at this point.”

The Catholic Medical Association (CMA), the nation’s largest organization of Catholic healthcare professionals, has issued a position statement that Plan B distribution is unethical and that the Peoria Protocol is flawed because of the potential for abortion.

“Simply put, it’s pure hypocrisy to continue to allow Plan B to be dispensed,” Dr. Kahlenborn said. The CMA noted in their position statement that the Peoria Protocol cannot be safely followed because (Plan B) cannot be given prior to ovulation without having a possible post-fertilization effect on a new human life.

“The reasons for supporting the use of Plan B in the Peoria Protocol are now really excuses that result in the death of our embryonic brothers and sisters. The Catholic Medical Association has studied the science for years and would never have published their position paper unless the scientific evidence was compelling.”

In 2013, the USCCB condemned the government’s decision to allow Plan B to be sold over the counter, making it readily available to young teens. But there has not been any movement, at least publicly, by the bishops toward reassessing their stance. Celebrate Life Magazine contacted the USCCB to inquire whether the bishops plan to evaluate the latest evidence but did not receive a statement before publication.

Protocol and episcopal policies on Plan B need to change

Two years ago, a letter was sent to every US bishop with the latest research findings on Plan B, Dr. Kahlenborn said, “. . . and I didn’t hear from anybody. I was frustrated. What’s wrong? What’s the problem? Are they just all afraid?”

Planned Parenthood and other women’s abortion centers dispense Plan B at no cost and encourage women to “have some on hand in case you need it.” The Catholic Health Association, which has taken positions contrary to Church teaching on issues such as the Health and Human Services mandate on contraception coverage in Obamacare health insurance plans has stated that it does not consider Plan B an abortifacient but emergency contraception.

“Plan B should be challenged, especially given the pro-life stance of the current administration, since abortion pills should not be sold over the counter to anyone, especially teenagers,” Dr. Kahlenborn said.

Dr. Kahlenborn remains convinced that the influential National Catholic Bioethics Center based in Philadelphia has the influence to be the agent-of-change on the issue.

“The USCCB has made no movement to change their position on the Peoria Protocol, despite overwhelming medical evidence over the past few years,” Dr. Kahlenborn said. “It is my strong impression that the USCCB takes its cues from the National Catholic Bioethics Center. Unfortunately, the NCBC still endorses the antiquated and totally disproven hypothesis that Plan B stops ovulation. This hypothesis has been debunked even by pro-EC researchers. I addressed the NCBC directly last year and showed them the evidence and they still remain unconvinced. Very disheartening.” He concluded, “I am literally stunned that the NCBC, who are mainly composed of ethicists and theologians, are trying to argue the merits of the science, when the Catholic Medical Association has already stated that the scientific evidence is more than sufficient to now conclude that the Peoria Protocol is fatally flawed.”

Dr. Kahlenborn visited their headquarters to lay out the research, but its ethicists there have been unwilling to budge on their position.

“The National Catholic Bioethics Center remains concerned about the possibility of an abortifacient effect when using Plan B, but believes that with appropriate testing, the risk of such an event is sufficiently diminished to allow for the use of this drug in limited circumstances,” said Ted Furton, an ethicist and director of publications for The National Catholic Bioethics Center, (NCBC) in a statement to Celebrate Life Magazine.

The National Catholic Bioethics Quarterly has published numerous articles pro and con on Plan B and its use. These studies are often highly technical. Plan B clearly poses dangers if a woman has conceived. The embryo may not successfully implant in the uterus. Therefore, careful testing is necessary to ensure that there is little-to-no likelihood that a woman has recently conceived before using this drug.

“The National Catholic Bioethics Center regularly meets to discuss pressing moral issues in healthcare, including the so-called Peoria Protocol. The Center continues to review published material on this topic as it becomes available. As of yet, there has been no change in our views on this matter.” Dr. John Haas, president of the NCBC, added, “We’re constantly studying this. We just don’t think the evidence is there.”

Dr. Kahlenborn was stunned by the response from this influential organization. While ethicists argue that there is no moral certainty, he said the medical evidence in most recent years gives one more than enough cause to pause the current Peoria Protocol: a similar conclusion was reached by the Catholic Medical Association’s in 2015, as noted on their position statement on emergency contraception. Dr. Kahlenborn noted: “It’s simply incomprehensible that the NCBC remains in denial regarding the most recent evidence when one considers that all of the top world researchers on Plan B, such as Dr. Horacio Croxatto and Dr. James Trussell—both of whom support Planned Parenthood—openly publish that Plan B does not effectively stop ovulation!”

“The studies the NCBC claim to support” that fertilization is impossible “do not support it at all and now new animal research and a human in-vitro trail have both shown that fertilization occurs with absent (Luteinizing Hormone) levels, disproving their hypothesis.”

Until the protocol changes and more bishops revamp their policy on Plan B, more babies face the possibility of death by abortifacient.

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Patty Schneier

In "Prove it God" Patty Schneier speaks as a Catholic woman and mother in our modern times. She tells her personal story of how God worked in her heart to turn her away from contraception and toward Natural Family Planning.

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